A Voice of Hope: The Melisa Cano Story

One of the biggest challenges speech-language pathologist Melisa
Cano says her students face has nothing to do with breath
control, pitch or articulation. It's "being teased, made
fun of and having people thinking they're not
intelligent."

To counteract this, Melisa visits classrooms and student
groups to talk about her profession. More often than not, the
students will reveal that they know people in their own lives
with speech difficulties.

"My uncle stutters."

"Do you love him?"

"Yeah."

"Then why would you make fun of him?"

"It's getting kids to understand," Melisa
explains.

But it's more than technical knowledge and encouraging
words that Melisa brings to these discussions. She offers her own
extraordinary story of recovery, perseverance and
accomplishment.

Rachel Torres, manager of speech-language pathology and
audiology services at San Joaquin General Hospital, reflects upon
the remarkable individual she saw as both patient and
student.

"I recall being slightly concerned about Melisa's
persistent hypernasal speech and whether patients and their
families would take issue," says Torres. "The opposite
occurred. Patients and their families were so inspired by
Melisa's recovery and fortitude that it provided them with
renewed hope."

A Tragic Accident, A Life Altered

Before one fateful morning in November 1996, Melisa Cano had
been the mother of a 3-year-old daughter, Brihana, and a student
at Madera Junior College considering a career in medicine. While
driving on Highway 88 near Jackson, California, she attempted to
slow down as a car trying to pass entered her lane. Her brakes
locked, sending the car spinning into oncoming traffic. The
impact instantly killed her daughter and left Melisa in a
coma.

Melisa's sister, Cathleen Villarreal, remembers receiving
the phone call from her mother, and receiving gentle words of
caution from hospital doctors to prepare for the worst and to
"make arrangements."

"But suddenly, on the third day, Melisa opened her
eyes," says Cathleen. "Her doctors predicted a three-
to five-month stay at the hospital, but once again, Melisa proved
them wrong! She walked out of that hospital a short six weeks
later."

The accident left Melisa experiencing double vision with no
lateral gaze-this required retinal surgery to correct. She
continued to have severe dysphagia (difficulty swallowing), which
required her to have a feeding tube in her stomach, and struggled
with profound dysarthria (weakness of the mouth, throat and chest
muscles) and cognitive linguistic deficits.

Recovery: The Immediate Challenge

For example, Melisa engaged in rigorous homework to recover
her immediate, short-term and long-term memory. Friends and
family helped her with pictures and stories that served as memory
triggers.

"A lot of my childhood is gone. And I'm horrible at
names." She used to be really good with remembering names,
she says.

She also started numerous exercises to regain the seemingly
simple functions of breath control and swallowing, such as
holding her breath, opening and closing her vocal cords.

"It's so weird. Your mind says 'I know how to do
this,' but you lose the triggers. I have no gag reflex. I had
to learn how to breathe while eatingâ€¦ (It's) the little
things you think you'll get back. I always thought I'd
regain how to speak and how to swallow."

This involved work with a "really uncomfortable to
wear" speech bulb, or obturator, and rigorous voice therapy
with her professor and on her own. Some of the challenge was
physical in nature, such as soft palate dysfunction that had
resulted in severe nasality in her speech.

Setting the Bar High, and Surpassing It

In fall of 1997, less than a year after the accident, Melisa
enrolled in courses at Madera Junior College.

According to Cathleen, "Her psychiatrist issued a 26-page
report in which he discouraged this particular course of action.
'She may be setting the bar too high,' he informed us.
Once again Melisa ignored the naysayers and carried on! She spent
50-plus hours a week studying, overcoming the frustrations and
memory delays caused by the accident. She would spend countless
hours reviewing materials until she got it."

"I didn't really know my limitations when I went
back," Melisa admits. "Cognitively, I had to adapt to
being not as smart as I was.

Before the accident, I could go into a classroom and just
highlight notes. I never had to study. I had a crazy
memory."

Melisa's still-formidable intelligence and memory skill
helped her adapt after the accident.

"I began to take copious notes" writing in four
different inks with a multi-ink pen: topics in black, definitions
in red, examples in green, everything else in blue.

In 1999, she enrolled in the speech-language pathology
graduate program at the University of the Pacific.

Regaining Her Voice

As she pursued her graduate studies, she realized it was time
to focus on her speech.

"When you're in the hospital, you're caught up in
learning day-to-day functions. I was really unintelligible going
back to school.

I would only speak to people who knew me or
one-on-one."

"By the time I was going into the master's program, I
was 100 percent intelligible but had a nasal quality, similar to
someone who's hearing impaired."

She would constantly monitor the quality of her voice,
practicing sentences for rhythm and stops, controlling nasal
sounds and constantly gauging characteristics such as cloudy vs.
pristine.

"Your voice has a certain tone," Melisa explains.
"My habitual pitch level, or fundamental frequency, was low
for a female of my age. In sentences, I would speak at 187 to 190
cycles per second. I was speaking in my chest, not projecting my
voice."

Guiding Her Own Treatment

Pivotal to refining the quality of her voice was an
experimental treatment involving her palate, treatment to which
she brought a unique contribution as both patient and
student.

Melisa's speech-language pathologist introduced her to Dr.
Granger Wong, a plastic surgeon from the University of
California, Davis.

The conversation soon turned to a material he was using to
treat cleft palates-and then came a sudden idea inspired by the
hypernasality of Melisa's speech, which resulted from her
soft palate inadequately closing off the nose from the mouth,
letting air and sound escape through the nose during speech.

"I bet if I injected this into the back of your
throatâ€¦" Dr. Wong speculated.

And that's exactly what he did-in a pioneering
implementation of Dr. Wong's posterior pharyngeal (throat)
wall implants, guided by Melisa's knowledge as a student and
patient.

Rachel Torres remembers one of the experimental treatments.
"The radiologist, department manager and I looked on as Dr.
Wong stuck what looked like a foot-long needle into Melisa's
pharyngeal wall, injecting it with implant material. The
department manager and I nearly passed out. I thought, what an
amazing individual to be so brave and determined to try this new
procedure."

The treatment was an uncommon example of the patient being
able to offer in-depth technical guidance on her own treatment.
Because Melisa had no sensation in the back of her throat, she
could be alert during the procedure and direct Dr. Wong's
maneuvering of the six-inch needle.

"He would inject it. I would say a sentence," says
Melisa. "You could immediately tell the difference. Being
able to feel the contact, then my being able to guide what was
going on-it was the perfect situation."

"I recorded my voice an hour after, and it sounded a
million times better."

To date, Melisa has undergone the semi-permanent treatment
three times. She currently is focusing on fine-tuning the muscles
in her throat.

In 2003, she graduated from UOP with a master's degree in
Speech-Language Pathology. She followed this with six months
serving a clinical fellowship at San Joaquin General Hospital-the
same hospital where she received treatment.

Teaching from Experience

Melisa's first teaching job was as a long-term substitute
speech-language pathologist at Jefferson Elementary School in
Tracy, California. Today she's at Ceres Unified School
District in Ceres, California. Her personal experience brings
rich insight-sometimes in unexpected ways-to her work helping
children with communication delays and impairments.

For example, she can't yell, sing, raise her voice, or
give her speech much inflection. Yet this is actually an
advantage in the classroom, she says.

"It's helpful for the kids. I never raise my voice,
so they know to concentrate."

She uses voice techniques with students with hearing loss. She
helps students who stutter to articulate, speak in shorter
utterances and slow down their speech-all techniques learned
first-hand.

Her students have ranged from preschoolers to adults in
continuing education. Some have speech that is less intelligible.
Often, the cause is language-based; these students have missed
learning a group of sounds. To compensate, they substitute other
sounds, and don't realize that these are not correct. Melisa
first helps them realize that other sounds are needed, then helps
them develop the missing sound groups, including learning how to
use them and when.

She also has worked with students with hearing loss who have
just received cochlear implants, helping them learn "what to
filter out and what to focus on, and how they perceive themselves
speaking."

One 14-year-old student is recovering from a stroke that
affected the right side of his body. With this student, she works
on redeveloping immediate memory recall through word finding and
using redundancy drills.

"It's scary to see a child deal with that."

A "Distinguished Consumer"-and an Inspiration

On March 31, 2006, Melisa's outstanding work with these
students and others was recognized beyond the borders of her
school district.

The California Speech-Language-Hearing Association recognized
her with its Distinguished Consumer award for her work advocating
for speech-language pathology while concurrently benefiting from
it. The ceremony featured a video with Melisa's university
professors, hospital colleagues and family, many of whom were in
attendance.

As Michelle Hulstrom wrote in her nomination materials,
"I am proud to call her my friend but more than that I am
proud to call her a colleague."

"Melisa is a living example of the miracle of
rehabilitation," wrote Rachel Torres. "Like her
therapist that inspired her, she will go on to inspire not only
her clients but also everyone who comes in contact with
her."

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About Us

The American Speech-Language-Hearing Association (ASHA) is the national professional, scientific, and credentialing association for 198,000 members and affiliates who are audiologists; speech-language pathologists; speech, language, and hearing scientists; audiology and speech-language pathology support personnel; and students.